title: Hemoglobin maintenance and dosing strategies using intravenous continuous erythropoietin receptor activator in Japanese hemodialysis patients.
abstract: Methoxy polyethylene glycol-epoetin beta, a continuous erythropoietin receptor activator (CERA), is reported to be effective in managing renal anemia but there is little data about CERA in Japan. This study aimed to ascertain the effects of CERA in Japanese hemodialysis patients and the appropriate starting dose of CERA when switching from other erythropoiesis-stimulating agents. We switched 61 stable hemodialysis patients to 4-weekly intravenous CERA, from either epoetin beta (rHuEPO) or darbepoetin alpha (DA). When determining the initial dose of CERA, we used guidelines recommended by the Japanese supplier for switching from rHuEPO, but for DA we based the CERA dose on European reports, because no Japanese guidelines exist. Fifty-two patients completed the 28-week study. Hemoglobin was maintained within the target range (10.0-12.0 g/dL). The required CERA dose decreased over the 28 weeks. The hemoglobin level and CERA dose stabilized faster when switching from DA. CERA showed similar efficacy in diabetic and non-diabetic patients. The effect of CERA is similar regardless of whether patients switch from low- or high-dose erythropoiesis-stimulating agents. In conclusion, CERA is effective for Japanese hemodialysis patients at a lower dose than expected.
authors.affiliation: Department of Internal Medicine, Harada Hospital, Hiroshima, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Hirai
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Nishizawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakazono
authors.forename: Mariko
authors.initials: M
authors.lastname: Asai
authors.forename: Hideki
authors.initials: H
authors.lastname: Yamashita
authors.forename: Ayako
authors.initials: A
authors.lastname: Sasaki
authors.forename: Tetsumasa
authors.initials: T
authors.lastname: Yamashita
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Yamashita
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Shigemoto
authors.forename: Satoru
authors.initials: S
authors.lastname: Harada
authors.forename: Sonoo
authors.initials: S
authors.lastname: Mizuiri
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D000068256:Darbepoetin alfa; D003920:Diabetes Mellitus / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D004921:Erythropoietin / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use*; D005260:Female; D006397:Hematinics / Q000008:administration & dosage / Q000627:therapeutic use*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D006435:Renal Dialysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D011994:Recombinant Proteins; C508420:continuous erythropoietin receptor activator; C103998:epoetin beta; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D011092:Polyethylene Glycols
keywords: Continuous erythropoietin receptor activator; Hemodialysis; Japanese patients; Renal anemia